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Cited by 1,193Obesity, Physical Activity, DietObesity and Health PracticesDiabetes, Cardiovascular Risks, and Lipoproteins

The obesity transition: stages of the global epidemic

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Jaacks, Lindsay M, Vandevijvere, Stefanie, Pan, An, McGowan, Craig J, Wallace, Chelsea, Imamura, Fumiaki, Mozaffarian, Dariush, Swinburn, Boyd +1 more·2019·The Lancet Diabetes & Endocrinology
DOI 10.1016/s2213-8587(19)30026-9PMC PMC7360432
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Abstract

The global prevalence of obesity has increased substantially over the past 40 years, from less than 1% in 1975, to 6-8% in 2016, among girls and boys, and from 3% to 11% among men and from 6% to 15% among women over the same time period. Our aim was to consolidate the evidence on the epidemiology of obesity into a conceptual model of the so-called obesity transition. We used illustrative examples from the 30 most populous countries, representing 77·5% of the world's population to propose a four stage model. Stage 1 of the obesity transition is characterised by a higher prevalence of obesity in women than in men, in those with higher socioeconomic status than in those with lower socioeconomic status, and in adults than in children. Many countries in south Asia and sub-Saharan Africa are presently in this stage. In countries in stage 2 of the transition, there has been a large increase in the prevalence among adults, a smaller increase among children, and a narrowing of the gap between sexes and in socioeconomic differences among women. Many Latin American and Middle Eastern countries are presently at this stage. High-income east Asian countries are also at this stage, albeit with a much lower prevalence of obesity. In stage 3 of the transition, the prevalence of obesity among those with lower socioeconomic status surpasses that of those with higher socioeconomic status, and plateaus in prevalence can be observed in women with high socioeconomic status and in children. Most European countries are presently at this stage. There are too few signs of countries entering into the proposed fourth stage of the transition, during which obesity prevalence declines, to establish demographic patterns. This conceptual model is intended to provide guidance to researchers and policy makers in identifying the current stage of the obesity transition in a population, anticipating subpopulations that will develop obesity in the future, and enacting proactive measures to attenuate the transition, taking into consideration local contextual factors.

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  • The transition to obesity was already apparent in adults in 1990 in much of the world, as demonstrated by the large number of countries in which adult obesity exceeded underweight at that time, and has since followed in school-aged children and adolescents.

    “Finally, the transition to obesity was already apparent in adults in 1990 in much of the world, as demonstrated by the large number of countries in which adult obesity exceeded underweight at that time, and has since followed in school-aged children and adolescents.7”

    From Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults (2024) · cites this paper as [7]

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Research works printed but not linked: 2

  1. [1]Thompson WS Population American Journal of Sociology 1929 34 959 75
  2. [90]National Center for Chronic Non Communicable Diseases Control and Prevention Report on the chronic disease risk factor surveillance in China 2013 Beijing Military Medical Science Press 2016

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Authors
Jaacks, L. M., Vandevijvere, S., Pan, A., McGowan, C. J., Wallace, C., Imamura, F., Mozaffarian, D., Swinburn, B., & Ezzati, M.
Affiliations
  • Harvard University (US)
  • University of Auckland (NZ)
  • Huazhong University of Science and Technology (CN)
  • University of Cambridge (GB)
  • Tufts University (US)
  • Deakin University (AU)
  • MRC Centre for Environment and Health (GB)
Corresponding author
Jaacks, Lindsay M
ORCID
Venue
The Lancet Diabetes & Endocrinology
Publisher
Elsevier BV
Published
2019-03
Volume
7
Issue
3
Pages
231-240
ISSN
2213-8587 (ISSN-L)
DOI
10.1016/s2213-8587(19)30026-9
PMC
PMC7360432
OpenAlex
W2913202413
Cited by
1,193
References
91
Citations by year
2026: 91 · 2025: 157 · 2024: 222 · 2023: 203 · 2022: 209 · 2021: 168 · 2020: 101 · 2019: 37 · 2018: 1 · 2015: 1
FWCI
21.09
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet Diabetes & Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Figshare (submittedVersion, cc-by)
  • Spiral (Imperial College London) (submittedVersion, cc-by-nc-nd)
  • Apollo (University of Cambridge) (submittedVersion)
  • Apollo
Funders
Medical Research Council (MC_UU_12015/5, MR/L01341X/1)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
obesity prevalence, global obesity epidemic, sex differences in obesity, socioeconomic status, childhood obesity, adult obesity, obesity epidemiology, conceptual model, obesity prevention policy
MeSH terms
Health Promotion, Humans, Obesity, Socioeconomic Factors, Global Health, Prevalence, Epidemics

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